Overcoming Obstacles: The Role of Suicide Stigma in US Veteran Help-Seeking

Background and Purpose:

Veterans accounted for 13.5% of all adult suicides in the US and were 1.5 times more likely to die by suicide than civilians in 2017. These high suicide rates may be related to attitudinal obstacles like stigma preventing Veterans from seeking help. To address the gap in research about Veteran suicide stigma and help-seeking, we asked the following research questions: (1) What does suicide stigma look like among US Veterans? (2) What is the relationship between suicide stigma and help-seeking intentions in US Veterans? We hypothesized that as suicide stigma increased, help-seeking intentions would decrease.

Methods:

The Suicide Prevention Climate Survey collected data from 1,247 US Veterans of all ages. Participants were recruited by Qualtrics using a quota sampling technique to create a sample that represents the US Census distribution of Veterans per geographical region. General, emotional, and suicidal help-seeking intentions were measured using the General Help Seeking Questionnaire. Suicide stigma was measured using the short form of the Stigma of Suicide Scale, with subscales created for stigma, glorification/normalization, and isolation/depression factors. The planned statistical analyses for this study included: a one-way repeated-measures ANOVA to compare suicide stigma subscale means; three linear regression models to see if suicide stigma predicted general, emotional, and suicidal help-seeking; and three independent t-tests using groups to compare suicide stigma between high and low help-seeking groups.

Results:

First, the one-way repeated-measures ANOVA found there were significant mean differences between the stigma (M = 2.66), glorification/normalization (M = 2.76), and isolation/depression (M = 3.75) subscales (p < 0.001). Second, the linear regression models found that all three suicide stigma subscales were significant positive predictors of the three help-seeking scales (all p-values < 0.001). Finally, the two-sample t-tests using groups found that high help-seekers reported higher mean levels of suicide stigma than low help-seekers (all p-values < 0.001).

Conclusions and Implications:

Contrary to our hypothesis, Veterans in our study who had more suicide stigma reported higher help-seeking intentions. One possible explanation for this is that Veterans with suicide stigma may be more motivated to seek help to avoid becoming a stereotype they dislike. Another explanation is that because our sample reported higher scores on the isolation/depression stigma scale, these Veterans may have reacted to their stigma by feeling sympathy for or trying to take the perspective of people who die by suicide.

Our results provide hope and encouragement for Veterans who are struggling because for our sample, suicide stigma was not necessarily an obstacle for help-seeking. Assuming future research in this area finds similar results, it would be important for practitioners working with Veterans to be open minded in how they view stigma, because there may be an overlooked benefit to suicide stigma. Our results also have implications for social change, specifically for Veteran Affairs mental health campaigns. The more we understand stigma and increase help-seeking, the more effective Veteran health care systems and suicide prevention efforts will be.